Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists. A place to talk; no one has to listen.
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Tuesday, April 03, 2012

A while back, one of our readers wrote a comment discussing the distress of being strip searched upon admission to a psychiatric facility. The reader felt this was particularly egregious because she had been a victim of sexual abuse and this insensitive treatment, unnecessary in her case, caused her to relive the distress of past sexual abuse and psychiatry should be about healing, not opening wounds and causing pain and suffering.

I felt badly for our reader. In fact, I felt badly for anyone put through such a practice, but I suppose I understand that outrageous and dangerous things happen in psychiatric hospitals and this could be a no win situation: what about the person who is assaulted by a patient who had a razor taped to their inner thigh that went undetected...wouldn't that patient feel it was awful that no one had searched the perpetrator? And staff on psychiatric units are not uncommonly assaulted, shouldn't they have the right to do what's necessary to protect themselves? I'm not sure that includes strip searches, but I suppose if there's a couple of stories of contraband or weapons or drugs being sneaked in, then policies change. One guy has an explosive in his sneakers 9 years ago, and millions of people are taking off their flip-flops every day in airports. I can't say that particular practice ever made me feel safer.

Okay, I also didn't know that psychiatric units strip search patients. I haven't worked on an inpatient unit in many years, and if this occurred, I imagine it was done by the nurses, if at all. Back then, I never heard a patient complain about this or even mention it, and in the years since, I've never had a patient mention being strip searched during an admission. I'm guessing that it's not a universal phenomena? Actually, I'm guessing that most hospitals don't strip search psychiatric patients, and really, if they do, I'd be pressed to know why just psychiatric patients, many people in hospitals have histories of unsavory behavior.

Okay, so just in case I'm not appalled enough, yesterday the Supreme Court, in Florence v. Bd. of Chosen Freeholders voted that anyone who is arrested, for even the most minor of crimes-- walking your dog without a leash, jay-walking, you name it--can be strip searched before being placed in jail. The court says that even minor violators can be dangerous, and note that Timothy McVeigh was arrested for driving without a license and one of the 9/11 terrorists was stopped for a traffic violation. Would strip searching them have stopped their terrorist attacks or prevented any future bad events? As doctors, we think in terms of risk, evidence-based medicine, best practices, statistical events, not anecdote, but I'm convinced that anecdote is much more powerful than science. And I don't think this supreme court decision bodes well for treating psychiatric patients any more humanely-- if it's no big deal to strip someone who didn't pay a traffic fine (for example, Mr. Florence in the above named case, but oops, he actually did pay the fine years earlier and there was a computer error, oh my), then I can't see why there would be sympathy for the dignity of anyone else.

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comments:

I have been strip searched in county jail when being processed for arrested for doing civil disobedience in my late-teens and my twenties. It was more upsetting to be looked at as a criminal than to be looked at by the woman doing the strip search telling me how to move my body. She had a dead look in her eyes. (Though I have to admit the first time was the worst when I was 18.) And is way pre-/9-11 and WTO and clearly the Seattle staff were not assessing "who" they were in taking into the system. They can't look at the person and guess as to whether they were falsely arrested and actually innocent. Scariest scenario: the prisoner is a good sociopath and can get sympathy from the most hardened jail guard and is not searched but kills 9 other prisoners for sport once inside with their hidden straight razor. This is why they can't operate that way. As much as I loathe this Supreme Court, the people who work at jails which house people of completely unknown capacity for violence, or not. They don't know. If you were arrested in New York City, where I went to graduate school (but was never arrested) I am sure you would want every single person coming in to Riker's Island, the most violent jail around to be strip searched. I have searched patients possessions before going onto an experimental unit for heroin detox when there was no one else with a license around to do it. They were not strip searched but we did ask the women to remove their bras under their shirts and shake them out as well take down their hair if it was up in a bun. The nurses on the unit gave them new unit underwear and scrub-like clothes to wear while their clothes were being laundered. I think this was a way of searching their clothes....The anorexics who were, oddly enough, on the same unit went through the same regime.One of treatment areas is PTSD and a strip search might trigger a lot of people, but being in a psych hospital would also offer many triggers to people with PTSD. Everyone's safety cannot be risked for fear of worsening someone's symptoms, otherwise no one would make it up to a unit ever....

I don't know how things are in the States. In Ireland, psychiatric facilities are not great places for healung, even without the strip search. There's a great book "Music and madness" by Ivor Browne, former head of psychiatric services in the state. Quite a damning indicement, and little has moved on since he wrote the book four or five years ago. A new model of care is needed for people who are fractured, to provide true places of healing where they can refind their wholeness

"...Supreme Court voted that anyone who is arrested...can be strip searched before being placed in jail (emphasis added)

SCOTUS did no such thing. They didn't vote on anything. They decided whether a New Jersey statute permitting strip searches violated the fourth amendment protection against unreasonable search and seizure. The majority, in a nuanced decision, decided that the statute does not violate anyone's 4th amendment rights. See this blog post by a law firm who opposes the ruling.

I warn all patients about this if I know they are going to be admitted. I also don't blame the hospital or wish to change the policy. I've seen too many staff injured by patients - and it's usually not the ones you expect. People surprise you, that's why they have to be all or none policies. Anything less is pointless.

Regarding strip searching inpatients, I can understand why some people would want that. But I also think there is probably a way to make that less humiliating than in a prison situation. I was thinking maybe offering some of these people a free physical exam. That would take care of the strip search. It might cost more and be more time consuming but whatever works. Free breast exam for concerned women! Free scoliosis check! I dunno. Whatever gets their clothing off. If it's done for a medical reason, that might make the whole thing less awkward.

And I think there really should be different policies for offenders who didn't pay a bill. It's just not the same thing as crashing planes into buildings. There are different levels of security (solitary confinement, gen. pop, ankle bracelet home imprisonment, etc.) I think people with minor traffic violations should just be put on an ankle bracelet first.

Like Dinah, I doubt the Supreme Court would strike down a psych unit's right to strip search patients. But I'm still guessing that *most* psych units don't. (Well, not the ones I've been in, heh.) I still think that making units report their use of strip-searching is a good tactic. They already have to report anytime they use restraints or seclusion. Psychiatrists should know the policies of units in their areas and refer accordingly. There are already numerous task forces on seclusion and restraint policy. Why shouldn't degrading full-cavity searches (and all the less degrading but still traumatic body searches) be studied with the same ferocity?

Free breast exams for concerned women? Only the most endowed of women could conceal anything in their breasts. That aside, I do go for regular breast exams, which have recently been declared useless anyway, and they never fail to set me off even with a doctor I know and have regard for. I don't think anyone will drawn in by the prospect of a free breast check. Its more traumatizing to be lied to. If it really must be done and I fail to be convinced that it always must be done, I would rather have a nurse sit down with the patient, no matter how psychotic the patient may be, no matter whether they come in in restraints and say in a calm voice, we have to make sure for safety and for ours that you don't have anything that you could use to harm yourself or others. This is something that everyone coming into the ward has to do. We will try to do this as gently as possible. Here is what we need you to do. (Outline what you need the patient to do. Make sure that a nurse of the same sex is present unless that is an issue for some reason. Provide a cover like in a doctor's office and only examine one part of the body at a time, providing for modesty and dignity as much as possible.)Having been strip searched on a psych ward, I will say that it was a bad experience but I was so out of it at the time that I don't recall it as the worst of my experiences there. In some sense, we get used to leaving our bodies and can tolerate a lot. It hurts a lot more to be spoken to like a bag of dirt by the nurses. The doctors were not so bad. Mine was pretty decent my last stay but the nurses had the power to kill your soul, as if that was needed. As for restraints, there are polices but they are rarely followed. I was restrained against policy. I was not violent. Of course, no one here will believe that. I will never go to a hospital again. They are the worst place for anyone with any illness. When I get cancer, I am going to Hawaii to die on the beach.

Well, I said that more to get them to take their shirts off...but that sucks that breast exams are pointless. I didn't know that. I really need to get a mammogram and the genetic test for breast cancer. It runs in the family, but I still think I may need to be pushy to get it covered by insurance. I'm in my 20s so I don't know that insurance will cover mammograms. And when I say breast cancer runs in my family I mean my mom died of it, her sister has it right now, her first cousin has it, her other first cousin is carrying the gene, her aunt died of it, and her grandmother died of it. Shockingly, her mother (my grandmother), never got it. But we have a weird strain. On my mom's side there is an invasive kind (the worst type of breast cancer you can get) and some "tubular" kind that is very slow moving. The tubular one seems to be the one that strikes in the lives of the women on my mom's side. The invasive one is the one that gets them young (in their 30s) and takes them down. My mom, at the age of 36, had both kinds of cancer.

Hers was a sad story. Mom knew she was gonna die. She had a really, really invasive kind that isn't really a lump. It's more like a small little pea sized thing that was on her breast. But the HMO wouldn't approve a mammogram. She went nearly a year desperately trying to get it biopsied but the GP couldn't get it approved. She finally went to the ER when her whole breast swelled, but they told her it wasn't cancer because she was in pain and she wouldn't be in pain. Then her breast lost its swelling. Sigh. By the time she finally got that little bump checked out, they found out she had the worst kind of breast cancer you could ever possibly get and that it had spread. I guess that explains that the breast stopped swelling...Sometimes I wonder if she had just gotten approved right away for a mammogram she would have survived. But my grandmother tells me that it wouldn't have mattered. Women usually don't survive that kind of cancer.

There was someone else in town with a problem like that. She was 17 and had a terrible lump. She went to different doctors but they kept telling her she was fine and there was no way it could be cancer. When she got her physical to join the peace corps right out of high school the peace corps doctor checked out her lump. She had Stage 4 cancer. She's dead now too.

Maybe free mammograms? Expensive but for a good cause. Though you are right...there is the issue of them possibly finding out they were lied to and that they only got a free mammogram so they could be strip searched.

Ugh...I got a breast exam about a year ago. Do I even want a mammogram? Maybe. It's good for every woman to have just so they know what their breast normally looks like. (Free mammograms for all!) What about the genetic test? Do I really want to know my expiration date?

The physical breast exam has been deemed pointless, even self exams and the yearly physician exam that I dread. The mammogram is still being debated with some believing it exposes women to cancer causing radiation over a lifetime and fails to detect cancer in many women while it picks up cancers that 'don't need to be treated" whatever that means, in other women. I still go pretty regularly. It runs in my family as well. I am also much older than 20s. It runs in my family as well. Go for the genetic test. I did. I don't have the gene but my friend found out she did and took steps to make sure she would not get breast cancer.

At both inpatient, short-term hospitals in a moderately large city in the midwest, patients are strip searched. One is a locked ward in a general hospital, one is a standalone mental health facility. This procedure has been in place for at least 5 years; I'm trying to remember the first time I remember one, but I was generally pretty messed up at admission time. The staff said it's because they have people smuggling in drugs or lighters or things. (Both places do detox and mental health crises on the same locked ward.)

It is upsetting under the best of circumstances and triggering/traumatizing under most conditions. But people were smuggling things in. It is currently to the point where you cannot have a pillow or stuffed animal from home either, for the same reason.

Don't look for compassion or healing from an acute-care, locked ward. They aren't to be found there. The only thing locked wards provide is safety from yourself until they can pump enough medications into you that you won't kill yourself (intentionally or accidentally) at home. They are for medication and monitoring, without time, staff or desire to provide therapy, compassion, or comforting.

I was angry when I heard the Supreme Court decision. I actually don't know if I was strip-searched or not because they injected me with a drug that put me totally out for several hours during transfer from the emergency room to the psych ward (in a different city). I woke up in a bed in the ward and my clothes had been replaced by a hospital gown so they could easily have strip searched me when they removed my clothes.

I understand the security reasons, but also agree with those above who suggest that a drape be used to "search" the body one body area at a time rather than require the patient to have to stand naked.

I don't think we can have this discussion without metrics. How many assaults occur annually with smuggled items out of how many total patients admitted? How many patients are re-traumatized by a strip search? What is the cost/benefit analysis? If we prevent one serious but nonfatal assault at the cost of traumatizing one hundred patients, is that acceptable? How about one assault per 1,000 patients traumatized? Are there alternatives that are less traumatizing that are equally effective (I'm thinking airport-style scanning)? What's the cost of a less-traumatizing alternative?And what is the cost/benefit ratio of the less-traumatizing alternative?

These are a few of the questions that come to mind. I think that too much of the analysis of whether to stip-search at a facility is probably based on gut-instinct, or reflexive thinking--somebody was assaulted somewhere, therefore we must strip-search everybody, everywhere.

Surely, before we as a society subject patients that are not accused of any crime to a traumatizing and humiliating search,we should do some careful analysis. The strip-search seems to be an example of mental-illness equals guilty of violent tendencies until proven innocent.

This is just one of the many reasons that I would meet force with force if anybody ever tried to involuntarily cart me off. Also one of the many reasons I would never go inpatient voluntarily.

The way I see it, I have no way of knowing that the meter reader, the appliance repair guy or the cop who comes by to interview me about a robbery down the road are not going to assault or kill me. Their badges could be fake. I think they should submit to strip search at my front door. The mail man is exempt but just because he does not cross the threshold. If he has a special delivery and I have to sign for it, watch out. If I put my house on the market, every agent and prospective buyer is going to strip. Coming to dinner at my place? Cavity search. Free breast exam, free prostate exam. Can never be too careful. Metrics? Thats for the Brits.

Cost/benefit analysis involving trauma as a factor? Whoa, I'm not sure how you'd operationalize that. Also, you're assuming that all traumatic events are a 'cost.' I'm not sure that's always true. All pleasant events are not beneficial (eg. a sudden inheritance that leads to a life of dissipation) and not all unpleasant traumatic events have a negative effect (eg. a near-fatal heart attack that leads to a permanent switch to a healthy lifestyle).

I think it would take some serious thinking to operationalize a measure of trauma. But difficult does not equal impossible. I'm critical of psychiatry at times, but I do believe that most of you folks are extremely intelligent and well-meaning. You could do it. I think there's a way, but no will.

Psychiatry uses written questionaire type measures all the time. Specifically, I'm thinking of depression scales and written screening tools for bipolar disorder. There are probably others. Surely a motivated psychiatrist or psychiatrists (or psychologist, for that matter) could develope a screening tool for trauma. You could probably also incorporate some objective measures.

I'm currently in a professional position with all the trappings (albeit, not on a doctor scale). House, car, office, friends. I've pretty much done this against some steep odds, because I'm also a survivor of some serious trauma, with some serious depressive episodes. If I were ever taken into custody against my will and forcibly stripped searched, I'd predict that I would spiral into such deep depression that I would probably end up on disability. Just a guess, but a very educated one.

That seems measurable to me. If you want to know the cost, ask the person who paid the bill. And while I agree that not all trauma is a cost, the only person qualified to judge that is the person traumatized.

i've been in six or so different psych hospitals. despite the fact that i am a pretty modest person, strip searching was far from the worst part of being forcibly admitted. in the majority of my hospitalizations, rather than strip search me, they made me go to the restroom and strip of every item of clothing i had on, and then had me put on a gown, pass out my clothing, and then put on a gown. a couple of times, i was so out of it when i was admitted that i didn't notice what was going on either way... i think it is fair to have someone put a gown on, then have a same gender staff person come into the room and have the individual shake the gown to demonstrate there is nothing hidden. at that point, the staff member can search through the clothing items so they can be put back on as quickly as possible. on two occasions, however, i snuck a razor into the psych unit when i was forcibly admitted-- once as a teenager, once as a young adult. (a very borderlinish thing to do, i realize now). neither of these times did a relatively thorough "search" find the weapon. i used it to harm myself and no one else. i think a thorough search and a metal detector is a good idea.

But another sure way to keep people safe would be to keep them in 5-point restraints at all times, right? We don't do this, and not just because it's impractical. At least I hope that's not the only reason: the inhumanity of it as a "treatment" matters too, right?

Apparently, some hospitals have learned to keep patients "reasonably" safe without strip searches. Are they just lucky? Do they just have fewer violent patients? Is the trend toward more or fewer invasive searches? This is where the metrics are needed. For me, the trauma of the search is a given. Sure, we take off our shoes in airports but we don't take off our clothes, even though we've had the Underwear Bomber.

I'm usually with the ShrinkRappers, but I can't help but notice how this question is dividing doctors and (for lack of a better word) patients.

Simple Citizen says: I also don't blame the hospital or wish to change the policy. I've seen too many staff injured by patients - and it's usually not the ones you expect. People surprise you, that's why they have to be all or none policies. Anything less is pointless.

I have concerns not only about the impact of this policy on patients, but also how it serves to reinforce stigma. It sends the message that patients with mental illness are people to be feared. That's the wrong message. How can we expect the public not to generalize, when we have hospitals doing just that?

Anon: You're right, psychologists and psychologists do have ways to measure subjective experiences and that wouldn't be hard to do. I should have explained myself better. I think the point that I was trying to make was that an outcome study wouldn't necessarily prove the point that trauma was harmful. For example, if one of the outcome measures was frequency and duration of subsequent hospitalizations, then the trauma of strip searches would "prove" (using the term extremely loosely) a benefit rather than a cost---because there would be fewer subsequent admissions.

The only thing a cost-benefit analysis would support would be the hypothesis that strip searches are a negative reinforcer---something that decreases the likelihood that a behavior (admission-seeking) would occur. But we already know this is true without a study, 'cuz that's what people here are saying.

The risk of a cost-benefit analysis is that "somebody" (insurance companies) might take a study like that to say that searches are "good evidenced based practice." Ugh.

""I have concerns not only about the impact of this policy on patients, but also how it serves to reinforce stigma. It sends the message that patients with mental illness are people to be feared. That's the wrong message. How can we expect the public not to generalize, when we have hospitals doing just that?""

Exactly Abbey Normal. Talk about stigmatization. Strip searching patients with mental illness who have not been arrested or committed a crime is the worst form and this seems to be accepted by psychiatry as business as usual.

This is justified because there have been incidents of violence although interestingly, we don't know what the statistics are exactly. But yet regular hospitals that have had attacks on staff don't institute strips searches or anything similar. They know if they did, they would get sued big time.

Unfortunately, because it is known that people with mental illness don't fight back usually, these abuses continue. Exception- someone in Massachusetts sued and those practices stopped.

But usually, it is going to be hard to find a lawyer because people with mental illness don't have credibility.

By the way, if state of PA can reduce seclusions considerably with a great reduction in staff injuries, you would think that the psych hospitals powers to be could figure out a way to make their hospital safe without the demeaning strip search or anything similar. But they have to want to problem solve instead of just taking the easy way out and treating patients as subhuman.

More than two dozen state psychiatric patients will get $5,000 apiece and the state has formally agreed to new procedures for searching patients, in settlement of a federal lawsuit stemming from strip-searches of 26 people at a state hospital.

The settlement also provides $70,000 to New Jersey Protection & Advocacy, a patients' rights agency that filed the class-action lawsuit in 2001, according to court papers. The suit was filed in U.S. District Court in Trenton on behalf of patients at the Garrett W. Hagedorn Gero-Psychiatric Center in Glen Gardner.

ClinkShrink--thanks for the clarification. I share your concern about how outcome measures can be designed to justify pretty much any result a person (or insurance company) wants to achieve.

I was thinking about a cost/benefit analysis in a somewhat different way than you seem to be. On the patient side, I was thinking specifically about cost/benefit to the patient in terms of whether patient outcomes are improved or degraded when a stip-search is conducted. I was thinking about outcome measures such as whether social functioning is improved or worsened (or whether the effect is null)immediately and over time, and whether being subjected to a strip search worsens existing symptoms immediately or over time. I was also thinking of costs to the patient such as what, in the law, we characterize as psychic damages--i.e. emotional distress. Although this one is hard to quantify, it's not impossible. Juries do it all the time and I think it is a legitimate consideration. If you strip search a patient, one cost to the patient will be, in most cases, emotional distress--psychic suffering that may vary from mild discomfort to acute emotional anguish. Is this cost to the patient worth whatever benefit accrues to the hospital in terms of improved staff safety?

On the hospital side, I was thinking more specifically about cost/benefits of alternative measures, such as scanning devices (really expensive, I know, and training is probably required, but judging by my interactions with TSA employees, if they can do it, a nurse or tech can do it with ease). It's also most likely a once-every-ten-years time cost, subect to amortization and chargeable as a business expense, so it may not be as expensive as it appears on its face. It's also probably more effective than a strip-search. So is the monetary cost to the hospital worth the benefit in terms of staff safety and reduced costs to the patient? Also, again, what is the actual cost to hospital staff in terms of injuries from assaultive patients. This is readily measurable, in terms of x assaults with smuggled instrumentalities (SI's) per y patients admitted; x injuries to staff from SI's per y staff hours worked; x dollars paid for workers from SI injuries per y hours worked, and probably many other ways I haven't thought of.

I agree, though, that outcome measures could be misused to justify strip searches in all cases by, as in your example, insurance companies, or by lawyers (uhgg) who used them to create a "reasonable standard of care."

I was told the reason for the strip search was to mark any scars or wounds. In other words, to protect the hospital in a liability issue. I do not have a history of self injury and do not have a diagnosis of any personality disorder.

This hospital was the second in a series of joint university hospitals in a major metropolitan city - #2 ranked in the US. They said it was their policy, though their other branch, which I had visited a year or so earlier, did not use strip searches.

I do not have a history of abuse of any sort but was horrified. I felt ashamed and violated. It was disgusting, and even worse to know it was to "protect" the hospital. Dinah, it had nothing to do with violence against staff or patients. Get your facts straight.

Oh boy, insomnia sucks. But at least I have my whole cost/benefits analysis to geek out about while I'm awake. So as long as I'm up, I'll just add this thought--I think the unspoken underlying premise of a blanket strip-search policy is that the importance of the health and well-being of a single hospital staff member (the benefit) outweighs the importance of the psychic damage to a single patient, a hundred patients, a thousand patients, a million patients (the cost). And I think the unspoken, and perhaps unconscious premise underlying that is that the mentally ill are somewhat less than fully human.

Okay, back to thinking about how I'll design the study and analyze the data after I win the lottery.

Strip searches aren't solely for the sake of staff safety. Smuggled drugs place other patients at risk for substance abuse relapse and/or worsened symptoms from intoxication. Intoxication and weapons place other patients at risk of assault too.

Regarding cost-benefit analysis:

Accredited hospitals are required to keep track of monthly assaults, so it shouldn't be difficult to sort out pre- and post-strip policy assault rates. At one point I searched the government crime reports regarding hospital-based murders and found that, while still rare, the rates have increased significantly over the last few years. (See my post The Year in Homicide.)

A national survey of hospital security chiefs done in 2010 showed that rates of felony offenses in hospitals increased by 70% from 2004 to 2009.

So the demand to improve hospital security isn't completely irrational. The effect on patients from a non-anecdotal standpoint remains to be seen.

As Anon mentioned, changes in symptom profile over time (lots of different ways to measure this---overall symptoms like with the HSCL-90, diagnosis-specific measures, some measure of trauma symptoms for patient with and without pre-existing trauma). Of course, all that assumes that strip searches are an experimental intervention requiring IRB approval. Which requires patient consent for participation. Ain't gonna happen, not in any meaningful way because people most likely to experience trauma from it are going to refuse.

So we're left only measuring impact on unit safety, which of course disregards the impact on individual patient's clinical status.

For the record, I agree that metal detectors are better than strip searches for weapons (although I've seen cases where weapons evaded detection by both methods, nothing is foolproof). I also think occasional visits from sniffer dogs are much better than strip searches, with the added bonus that many people like having an animal visit. (Pets on Wheels, trained for drugs?)

All that aside, one of the best weapons I know of is a fist. I believe they turn one or two of those up on almost ever search, strip or otherwise. I was once an inpatient on a ward with a guy who used his fists every single day. I had to sit next to him at meals. I was very careful not to say much if he was in one of fi(s)tful moods.

ClinkShrink--Thanks for your ongoing responses. The hospital data tracking monthly assaults would be interesting. But does it break out data in any useful way for analyzing this issue? For example, I'd want to know the specific unit where each assault occurred, whether the assault involved use of some kind of weapon, and whether the weapon was brought in from outside the hospital or was improvised from something found inside the hospital. The only meaningful analysis would be a comparison on rates of assault with a weapon brought in from the outside on inpatient psych units that strip-search vs. those that don't.

My guess would be that most assaults on inpatient units and most assault-related injuries to other patients and staff don't involve weapons brought in from the outside. I know from many years of hanging out with cops and corrections officers that anything's legal in a street fight and almost anything can be made into a weapon. I'm thinking most inpatient psych assaults and injuries likely involve bare fists or improvised weapons. But I've never been on an inpatient unit as either patient or professional, so really that's just pure guess.

With regards to unit security and drugs, we know from the corrections world that many jails and prisons are awash in drugs, improvised weapons and other contraband such as cell phones. If you want something bad enough in prison, and you have the money, you can probably get it. Prisoners are not routinely strip searched after they enter the corrections unit, unless there's cause. Psych units are probably much more tightly controlled than prisons, I think, but again, its just a guess. So why strip search? I'd like to think we treat our patients with at least as much respect as we treat our convicts.

With regard to looking at patient outcomes, I wasn't thinking of designing a prospective study requiring informed consent and IRB approval. I was more thinking of a post-hoc survey type of approach. Of course, that would also probably be impossible, because it would require disclosure of identities of former patients, and various laws (rightly so) would prohibit that. You'd have to find a way to call for volunteers who've been on inpatient units to come forward and participate in a survey.

Of course, this is all pie-in-the sky, I'm still awake at 3:00 a.m. what would I do if I won the lottery thinking because nobody is ever going to study this issue. There's no money in it, and the practical obstacles loom too large. Still, it would be nice to know that somebody was seriously weighing the costs of strip-searches to patients' mental health and short and long-term outcomes.

I put up this post because the Supreme Court just said it's okay to strip search any person who is arrested. The test case was a man who was wrongly arrested for an outstanding warrant for a traffic violation years prior--in fact, he HAD paid the traffic ticket. He was in jail for 4 days and strip searched twice.

If you are arrested for not wearing a bicycle helmet, you can now be strip searched, fine with the Supreme Court.

Fists really are a problem.

Personally, I think the most compelling argument against would be that some hospitals don't. Seems to me a metal detector wand followed by hand out your clothes would be fine. No one's doing body cavity searches anyway. Clink works in a forensic facility, so I think that's a different issue than a community psych unit.

Okay, I'm curious, is this routine? I had no idea. No patient has ever mentioned it to me, and if it was happening on the unit when I was a resident, I didn't know.

I understand the concerns about violence in hospitals. I've worked in hospitals (not psych area) for years and have at times felt threatened, so I really can understand and appreciate those concerns. They are valid concerns.

My problem with the policy is limiting it to psychiatric patients. If the policy was really about the interest of safety, then it seems we should have all patients upon admission strip under threat of force. This will never happen, though, because those who create and/or support the policies would also be affected.

In my case it was around 1997, and I was admitted as a voluntary patient. Having never been to a psychiatric hospital before I was already very afraid of what was going to happen. I still remember exactly where I was standing, what I was wearing, but most of all how I felt when I was told this is what I would have to do. My thinking at the time was that if they felt they needed to do this to me then having a mental illness was something very shameful. It had a profoundly damaging impact.

I think hospitals do have to consider safety, but I believe the cost of this policy is just too high. I would be interested in studies examining the rates of violence in hospitals pre and post implementation of these sorts of policies. I wouldn't be surprised if it actually increases hostility and escalates things.

Now that I think of it, I have been on an inpatient psych unit in a professional capacity. Many, many years ago as a young attorney, I was called down to a local psych ward to spring a very close friend who had been involuntarily admitted for being suicidal--incomplete attempt. Ironically, her suicidality was based on the fact that she had a terminal disease. After I duly made the requisite threats of litigation, they released her. She had been strip searched. It was deeply traumatizing for her.

@BPLady: I don't think my mother or the girl in my post had a problem with preventive care not being covered. I think it was a matter of them still being too young to qualify for it. I know my mother would have been approved for mammograms if she had been older. She was 36, and I think you had to be 40 to qualify for one. Also, she was presenting with unusual symptoms. There was barely a lump, she was in pain, and the breast was all swelled up. And they were used to seeing women with a noticeable lump, 40 or older, not in pain, and with no swelling of the breast. It was the same kind of problem with the girl, even though I think she had classic symptoms. They really didn't believe that 17 year old girls got breast cancer. So they just didn't check for it. In their brains, there was no way that lump was cancer. My mom and that girl defied everything they knew about who gets breast cancer and how it presents.

Even now, I don't know that I would qualify for a mammogram. I think it only becomes standard once you hit a certain age. If I were 40, I think it would be a given. But I'm in my 20s, so I think there are probably a lot of things I don't qualify for. Colonoscopies, etc. Personally, if any woman has any suspicious symptoms, no matter what the age, I think doctors and insurance companies should err on the side of caution.

Dinah, as a private practice doc that doesn't work in a hospital. What do you do when one of your patients gets admitted to hospital? How much of a say do you have in their care while in hospital? What about if you disagree with their opinions, diagnosis and treatment?Does a patient have the right to decide that they want you to decide which treatment should occur?I know that my doc knows my thoughts and opinions about certain topics and I trust him to keep these in mind when and if I get ill or get certain symptoms.Can you be elected as a voice by your patient if they are or feel unable to make decisions by themselves?

Do physicians collaborate much in this kind of a situation?

What about in non-psych cases?In my and my friends experiences there doesn't appear to be any collaboration.

And I know I've been in hospital asking my psychologist to speak for me, and I know he wasn't listened to cause he didn't agree with them.

What about in private facilities where there would be more of a focus on long term management and setting a patient up with a care plan?

And yes, I am going to ask my doc the same questions at my next appointment.

Bec

P.S. If I was this post would be preceded by me bringing scones and you making some tea. White please!

I've been in both jail as well as the "unit." In jail, I was not strip search. Instead, I was told to go into a room and change my clothes.

I was falsely reported as being suicidal and was sent to the psych ward. I had to take my clothes off behind a curtain. The male tech took my clothes, and didn't look at my body. He told me to get showered, so I did.

After I dried off, I was told to wait in the room until the nurse came in. Two women came in and one introduced herself as the nurse and the other was was an assistant. I was given a complete medical examination. I suspect that is was as much as a search as it was a medical examination.

In a medical examination, staff can get away with much more than they can with an ordinary strip search. I won't go into detail, but if I was hiding anything anywhere, it would have been found. It didn't bother me too much (I'm a guy) but I can see how it would bother some folks.

If someone has to go through one of these searches, I believe that it should be up to the person being search as to what sex the person doing the search will be.

The first time I was hospitalized for psychiatric reasons when I was 16, and not only did they do a strip search, they did a body orifice search. Three or four men--I'm female--took turns sticking their fingers in my vagina while laughing. "It's your turn. Does she have something hidden in there? [laughs] Wanna double check in case we missed something? [laughs]". The second time I was in a psychiatric hospital, a different one, I wasn't strip searched, so I assumed there had been a law banning it. But now I know there hasn't.